- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.66 / $915.40 / $1,209.36
| Professional | | $26.66 | $915.40 | $1,209.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.72 / $31.72 / $40.60
| Professional | | $31.72 | $31.72 | $40.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.61 / $46.61 / $46.61
| Facility | | $46.61 | $46.61 | $46.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.57 / $1,077.57 / $1,077.57
| Professional | | $1,077.57 | $1,077.57 | $1,077.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.13 / $1,504.48 / $2,018.94
| Professional | | $975.13 | $1,504.48 | $2,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.75 / $1,214.76 / $2,150.05
| Professional | | $919.75 | $1,214.76 | $2,150.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.04 / $1,606.26 / $1,784.73
| Professional | | $1,393.04 | $1,606.26 | $1,784.73 |